Ellis Penelope K, Martin Willam J, Dodd Peter J
Sheffield Medical School, University of Sheffield, United Kingdom.
School of Health and Related Research, University of Sheffield, United Kingdom.
PeerJ. 2017 Dec 14;5:e4165. doi: 10.7717/peerj.4165. eCollection 2017.
CD4 cell count in adults with human immunodeficiency virus (HIV) infection (PLHIV) not receiving antiretroviral therapy (ART) influences tuberculosis (TB) risk. Despite widespread use in models informing resource allocation, this relationship has not been systematically reviewed.
We systematically searched MEDLINE, Aidsinfo, Cochrane review database and Google Scholar for reports in English describing TB incidence stratified by updated CD4 cell count in cohorts of HIV-positive adults (age ≥15 years) not on ART (PROSPERO protocol no: CRD42016048888). Among inclusion criteria were: reporting precision for TB incidence, repeated CD4 measurements, and TB incidence reported for those not on ART or monotherapy. Study quality was assessed via the Newcastle-Ottawa tool for cohort studies. A Bayesian hierarchical model was fitted to estimate the pooled factor increase in TB incidence with respect to CD4 cell count decrement.
A total of 1,555 distinct records were identified from which 164 full text articles were obtained. Common reasons for exclusion of full texts were: no valid TB incidence, no repeat CD4 measurements, and not reporting TB incidence by ART status. The seven studies included reported on 1,206 TB cases among 41,271 individuals, with a typical median follow-up of four years. Studies were generally rated as moderate or high quality. Our meta-analysis estimated a 1.43 (95% credible interval: 1.16-1.88)-fold increase in TB incidence per 100 cells per mm decrease in CD4 cell count.
Our analysis confirms previous estimates of exponential increase in TB incidence with declining CD4 cell count in adults, emphasizing the importance of early ART initiation to reduce TB risk in PLHIV.
未接受抗逆转录病毒治疗（ART）的成人人类免疫缺陷病毒（HIV）感染者（PLHIV）的CD4细胞计数会影响结核病（TB）风险。尽管该关系在用于指导资源分配的模型中被广泛应用，但尚未得到系统综述。
我们系统检索了MEDLINE、Aidsinfo、Cochrane综述数据库和谷歌学术，以查找英文报告，这些报告描述了未接受ART的HIV阳性成人（年龄≥15岁）队列中按更新后的CD4细胞计数分层的结核病发病率（PROSPERO方案编号：CRD42016048888）。纳入标准包括：结核病发病率报告的精确性、重复的CD4测量，以及未接受ART或单一疗法者的结核病发病率报告。通过纽卡斯尔-渥太华队列研究工具评估研究质量。拟合贝叶斯分层模型以估计结核病发病率相对于CD4细胞计数下降的合并因素增加情况。
共识别出1555条不同记录，从中获取了164篇全文文章。排除全文的常见原因包括：无有效的结核病发病率、无重复的CD4测量，以及未按ART状态报告结核病发病率。纳入的七项研究报告了41271名个体中的1206例结核病病例，典型的中位随访时间为四年。研究总体被评为中等或高质量。我们的荟萃分析估计，CD4细胞计数每降低100个细胞/mm³，结核病发病率增加1.43倍（95%可信区间：1.16 - 1.88）。
我们的分析证实了先前关于成人结核病发病率随CD4细胞计数下降呈指数增加的估计，强调了尽早开始ART以降低PLHIV结核病风险的重要性。
